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Abducens Nerve Palsy Treatment & Management

  • Author: Michael P Ehrenhaus, MD; Chief Editor: Edsel Ing, MD, FRCSC  more...
 
Updated: May 17, 2016
 

Medical Care

Truly isolated cases often are benign. They can be followed with a serial examination, at least every 6 weeks, over a 6-month period to note decreasing symptoms (diplopia) and resolution of the paretic lateral rectus (increasing motility).[12, 3] Prism measurements are a simple objective method of documenting any changes in the esotropia.

Children with sixth nerve palsy who are in the amblyopic age group can be treated with an alternating patching to decrease their chances of developing any amblyopia in the paretic eye. Additionally, prescribing the full amount of hyperopic correction helps to decrease the esodeviation by relaxing the child's accommodative effort.

Adult patients and those children beyond the amblyopic age can be patched or have their lenses "fogged" with clear tape or nail polish to reduce their diplopia. Fresnel prisms also can be prescribed as an alternative.

Older patients in whom giant cell arteritis is suspected should start the standard treatment with prednisone or intravenous methylprednisolone.

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Surgical Care

If, after 9-12 months of follow-up care, the remaining deviation is still unacceptable and is too large to be corrected with prisms, surgical corrective options should be discussed with the patient. The procedure that is chosen depends on the remaining function of the lateral rectus and the experience of the surgeon.

If some residual function exists in the lateral rectus, a graded recession of the medial rectus or botulinum toxin to the medial rectus and resection of the lateral rectus can be performed.

When little or no residual function is present, a transposition of the vertical recti toward the lateral rectus (eg, Hummelsheim or the Jensen procedure), can be considered in conjunction with weakening of the ipsilateral medial rectus.

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Consultations

Patients with abducens palsy can benefit from consultation with a neurologist, ophthalmologist, or neuro-ophthalmologist, especially if the lesion does not resolve.

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Activity

Patients who occlude an eye to alleviate diplopia should be warned that the resulting effects on depth perception may interfere with their ability to drive or perform certain occupations safely.

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Contributor Information and Disclosures
Author

Michael P Ehrenhaus, MD Director, Department of Cornea, External Disease & Refractive Surgery, Assistant Professor, Department of Ophthalmology, State University of New York Downstate Medical Center

Michael P Ehrenhaus, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists

Disclosure: Nothing to disclose.

Coauthor(s)

Mohammedyusuf E Hajee, MD Clinical Instructor, Staff Physician, Department of Ophthalmology, Director, Blood Flow Laboratory, State University of New York-Downstate Medical Center

Mohammedyusuf E Hajee, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, Southern Medical Association

Disclosure: Nothing to disclose.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.

References
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  10. Anwar S, Nalla S, Fernando DJ. Abducens nerve palsy as a complication of lumbar puncture. Eur J Intern Med. 2008 Dec. 19(8):636-7. [Medline].

  11. Tsai TH, Demer JL. Nonaneurysmal cranial nerve compression as cause of neuropathic strabismus: evidence from high-resolution magnetic resonance imaging. Am J Ophthalmol. 2011 Dec. 152(6):1067-1073.e2. [Medline]. [Full Text].

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